1. Making Prevention Easier for Providers September-October 2011

2. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 2 Welcome One of the major initiatives this year for Health Net Federal Services, LLC (Health Net) is to improve cancer prevention and diabetes care screening rates. Our Goal: Improve the rates by three to five percent. Our Purpose: Help beneficiaries stay healthy. Our Reason: TRICARE network beneficiaries across the country have lower screening rates than the national average. In an effort to accomplish our goal, we are partnering with network physicians and reaching out in various ways to beneficiaries, which are highlighted in this presentation.

3. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 3 Todays Goals Upon completion of todays presentation, you should be able to: 1)Identify the preventive screenings being targeted and measured by Health Net. 2)Access online tools for both beneficiaries and providers. 3)Identify three evidence-based interventions to improve prevention screenings.

4. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 4 A Screening Story Recently, my doctor informed me during a regular check-up it was time for my routine mammogram. He wrote a script and handed it to me. Before I left the office, the assistant handed me a flyer that described the test and provided some general information. After that, I carried around the script and flyer, of course intending to make the appointment but somehow, with work and dealing with everyday life events, I just never got around to it. Isn't it ironic that I work in the Preventive Care Services department promoting the importance of getting screened, and here I was not current in my preventive screenings? A little over three weeks after the appointment with my doctor, I received a call from the doctor's office. The assistant said they had not yet received the results from my mammogram and wanted to make sure I had gone for my screening. It was this call that did it. This call, and the reminder I could schedule my appointment online with only a few clicks. If my doctor cares enough to check up on me, how could I not get my mammogram? And so it was that I got my screening.

5. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 5 Why Preventive Screenings Screenings save lives. Screenings detect illness for earlier intervention. Preventive care is covered under TRICARE. Healthy patients rate higher satisfaction with their care and providers. Improving screening rates is one of Health Nets key initiatives.

6. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 6 Diabetes Screening Guidelines* (Applies to Diabetics Only) [American Diabetic Association] Cholesterol (LDL-C blood test)Annually HbA1c blood test2x/year Retinal eye examAnnually Cancer Screening Guidelines Mammography [American College of Radiology] Every year starting at age 40 Pap smear [American Congress of Obstetrics and Gynecology] Every 2-3 years starting at age 21 (TRICARE benefit is one per 12 months) Colorectal Cancer Screening Guidelines (One of the Following) [American College of Gastroenterology Recommendations] FOBTEvery year starting at age 50 Flexible SigmoidoscopyEvery 5 years starting at age 50 (TRICARE benefit is one every 3 years) ColonoscopyEvery 10 years starting at age 50 Which screenings are a focus? TRICARE benefits match the above guidelines except where noted. *Diabetes screenings are not covered under preventive care benefits. A beneficiary cost-share applies. Other widely accepted clinical guidelines exist that may recommend screenings at different frequencies.

7. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 7 What are the targets? Type of Screening NCQA 2010 National Commercial HMO Average (for CY 2009) Colorectal Screening60.7% Breast Cancer Screening71.3% Cervical Cancer Screening77.3% Diabetic HbA1c Testing89.2% Diabetic LDL-C Testing85.0% Diabetic Retinal Eye Exam 56.5%

8. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 8 What does it take? According to Yarnell et al., it would take a primary care physician 7.4 hours per day to satisfy the U.S. Preventive Services Task Force recommendations on preventive screenings. In other words, if a primary care physician is going to deliver preventive services adequately, the health plan needs to assist. Yarnell et al. Primary care: Is there enough time for prevention? American Journal of Public Health (2003), 93(4), 635-641.

9. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 9 About Patients and Prevention Patient Perception on Prevention: Three Groups Group 1: Eager to be screened The challenge is preventing overuse and misuse. Group 2: Need a little nudge A physician recommendation is sufficient. Group 3: Unwilling or unable More than a recommendation is needed. Multilevel interventions such as reminders and tracking, and community- based approaches are needed. These groups challenge the resources of the average practice. Health Net can help. From a presentation by Chyke Doubeni, MD, at the 2011 Dialog for Action on Colorectal Cancer Screening Doubeni. Ann FamMed. eLetters, Jul 22, 2010 CuzickJ, et al. Statistics in Medicine. 1997;16(9):1017-29

10. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 10 Predictors of Screening Compliance Having a primary care physician Getting a recommendation to obtain screening from a primary care physician Having a connection to a primary care practice (if not a single, consistent physician) Donald Neace, Jr., MD, Dialog for Action, March 2010.

11. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 11 Evidence-Based Interventions 1.Recommend Your recommendation is the single most influential factor in persuading patients to be screened or tested. 2.Create an office policy about prevention Make sure all office staff are aware of the policy and know how to implement it, including identification of local resources. 3.Have a reminder system Reminder systems can include electronic flags, chart prompts or labels, audits, ticklers/logs and staff assignments. Reminders can target patients, providers and office staff.

12. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 12 Evidence-Based Interventions 4.Educate Consider patient preferences and stage of readiness. Use educational tools: handouts, videos, websites. 5.Reduce barriers Make it easy for patients to schedule appointments. Provide lists of convenient sites/providers. Make phone calls to arrange services. Allow patients to make appointments via the Internet. For additional information on evidence-based interventions for cancer screenings, see www.thecommunityguide.org/cancer.

13. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 13 Tools Free Health Net phone- based education classes for TRICARE beneficiaries Topics: diabetes, smoking cessation, asthma, heart failure Promotional materials available Patient overdue screening notification template letter Download and use with your own stationery and signature Patients can sign up for automatic reminders via Internet American Cancer Society for mammography (www.cancer.com, click Stay Healthy, Tools & Calculators, Reminders)www.cancer.com MyHealthTestReminder.com for colorectal screening, Pap smear, mammography and other exam reminders Patient handouts, posters and articles on: Mammography Pap smear Colorectal cancer screening www.hnfs.com, Provider, Wellness, Resources, Toolkitswww.hnfs.com

14. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 14 Health Nets Website – www.hnfs.com

15. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 15 Health Nets Website – Resources for Providers

16. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 16 Health Nets Website – Impact Provider Impact Provider offers: Online access to patient diagnoses, procedures, medications, and specialty referrals/care Ability to view individual patient summaries including utilization and pharmacy information, concurrent providers and care opportunities Visibility of patient compliance with refilling ordered medications Quality profile for civilian network providers, showing overall completion rates for preventive screening measures Printable information for placement in patients charts Online training module Impact Provider is an online tool that uses administrative information from claims and encounter data to give providers access to their TRICARE patients diagnoses, tests, medications and more. This information is organized in a user-friendly way intended to help providers proactively manage their patients and administer optimal care.

17. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 17 Impact Provider The link to Impact Provider can be found under Resources on www.hnfs.com. Note: Registration on www.hnfs.com is required to access Impact Provider.

18. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 18 Impact Provider – Patient Summary

19. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 19 Impact Provider – Quality Profile

20. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 20 Are you interested? Join Health Nets effort to raise screening rates. Receive a quarterly spreadsheet identifying all of your TRICARE beneficiaries overdue for screenings. Receive tools to enhance your screening processes. Communicate directly with Health Nets Clinical Quality staff.

21. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 21 Summary The primary care provider and practice have the most influence on whether beneficiaries obtain preventive screenings. Have the conversation. Recommend, use reminders, reduce barriers and share screening stories. Follow up. Let us know how we can help you and your practice be more effective.

22. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 22 Health Net Preventive Screening Contacts Laura Benson, RN, MSN, CPHQ 571-227-6499 Laura.S.Benson@healthnet.com Kimberly Komar 571-227-6496 Kimberly.N.Komar@healthnet.com Provider Network Management Contract Representative or PRO (Provider Relations Outreach Specialist) Market Manager (reach through local TSC)

23. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 23 Questions and Answers